Cardiology Department, ELSAN, Clinique du Pont de Chaume, 82000 Montauban, France.
Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, AP-HP, 75013 Paris, France.
Arch Cardiovasc Dis. 2019 Aug-Sep;112(8-9):485-493. doi: 10.1016/j.acvd.2019.05.004. Epub 2019 Jul 26.
Data on the long-term outcome of heart transplantation in patients with a ventricular assist device (VAD) are scarce.
To evaluate long-term outcome after heart transplantation in patients with a VAD compared with no mechanical circulatory support.
Consecutive all-comers who underwent heart transplantation were included at a single high-volume centre from January 2005 until December 2012, with 5 years of follow-up. Clinical and biological characteristics, operative results, outcomes and survival were recorded. Regression analyses were performed to determine predictors of 1-year and 5-year mortality.
Fifty-two patients with bridge to transplantation by VAD (VAD group) and 289 patients transplanted without a VAD (standard group) were enrolled. The mean age was 46±11 years in the VAD group compared with 51±13 years in the standard group (P=0.01); 17% of the VAD group and 25% of the standard group were women (P=0.21). Ischaemic time was longer in the VAD group (207±54 vs 169±60minutes; P<0.01). There was no difference in primary graft failure (33% vs 25%; P=0.22) or 1-year mortality (17% vs 28%; P=0.12). In the multivariable analysis, preoperative VAD was an independent protective factor for 1-year mortality (odds ratio 0.40, 95% confidence interval 0.17-0.97; P=0.04). Independent risk factors for 1-year mortality were recipient age>60 years, recipient creatinine, body surface area mismatch and ischaemic time. The VAD and standard groups had similar long-term survival, with 5-year mortality rates of 35% and 40%, respectively (P=0.72).
Bridge to transplantation by VAD was associated with a reduction in 1-year mortality, leading critically ill patients to similar long-term survival compared with patients who underwent standard heart transplantation. This alternative strategy may benefit carefully selected patients.
关于心室辅助装置（VAD）患者心脏移植的长期结果数据很少。
评估 VAD 患者心脏移植后的长期结果，并与无机械循环支持的患者进行比较。
在单中心高容量中心，连续纳入 2005 年 1 月至 2012 年 12 月期间接受心脏移植的所有患者，随访 5 年。记录临床和生物学特征、手术结果、结局和生存率。回归分析用于确定 1 年和 5 年死亡率的预测因素。
共纳入 52 例 VAD 桥接移植（VAD 组）和 289 例无 VAD 移植的患者（标准组）。VAD 组的平均年龄为 46±11 岁，标准组为 51±13 岁（P=0.01）；VAD 组 17%的患者和标准组 25%的患者为女性（P=0.21）。VAD 组的缺血时间更长（207±54 与 169±60 分钟；P<0.01）。原发性移植物衰竭率无差异（33%与 25%；P=0.22），1 年死亡率也无差异（17%与 28%；P=0.12）。多变量分析显示，术前 VAD 是 1 年死亡率的独立保护因素（比值比 0.40，95%置信区间 0.17-0.97；P=0.04）。1 年死亡率的独立危险因素包括受体年龄>60 岁、受体肌酐、体表面积不匹配和缺血时间。VAD 组和标准组的长期生存率相似，5 年死亡率分别为 35%和 40%（P=0.72）。
VAD 桥接移植与 1 年死亡率降低相关，使危重症患者与接受标准心脏移植的患者具有相似的长期生存率。这种替代策略可能使经过精心选择的患者受益。
